介入疗法在妇科恶性肿瘤治疗中的价值初探

目的 探讨介入疗法在妇科恶性肿瘤治疗中的价值。方法 选择我院1997年9月至1998年6月经病理证实的晚期妇科恶性肿瘤患者24例，采用Seldinegr法选择性地行髂内动脉化疗药物灌注，在注药后不同时间取活组织行病理观察，并于介入治疗后2周用B超检测肿瘤大小。结果 灌注药物前盆腔动脉造影显示，全组患者的子宫动脉增粗、扭曲，可见肿瘤新生血管和肿瘤染色现象，部分病例还可见肿瘤血管湖，动静脉交通等影像。注药后24小时病理组织不观察见肿瘤细胞呈片状坏死，72小时坏死更为彻底。灌注化疗后完全缓解2例。部分缓解19例，无缓解2例，无效1例。化疗副作用轻，化疗后2周内白细胞恢复政治完1例并发症发生。结论 （1）盆腔动脉造影对于观察疗效和了解病变范围具有重要的指导意义。（2）化疗后肿瘤缩小，为手术切除创造了条件，在灌注化疖周后手术较为时宜；对化疗后部分不能手术的患者。病灶缩小也更有利于放疗。（3）介入疗法具有操作方法简单、疗效佳、并发症及副作用少等优点，是挽救病人生命的积极有效措施之一。

Investigation on the value of applying interventional radiologic treatment in the management of advanced gynecological malignancies]

OBJECTIVE: To investigate the value of applying interventional radiologic treatment (IRT) in the management of advanced gynecological malignancy. METHODS: Twenty-four historically confirmed advanced gynecological malignancy patients from September 1997 to June 1998 were included. After receiving internal iliac arterial infusion chemotherapy with Seldinger, the patients' tumor tissues were pathologically studied at different times. The tumor size was measured by ultrasonography two weeks after IRT. RESULTS: Before internal iliac arterial infusion chemotherapy, internal iliac arteriography showed that uterus artery was thickened and tortuous, the new vessels appeared and the tumors were stained. In some cases, the image of blood vessel-lake and arteriovenous shunt were seen in tumor tissues. Twenty-four hours after internal iliac arterial infusion chemotherapy, focal necrosis was observed in tumor cells, seventy-two hours after, the necrosis became more thorough. In regard to the tumor size, two patients were CR, nineteen patients were PR, and two patients were NC. Only one patient failed to respond to IRT. Chemotherapy side effects were slight. Patients' WBC returned normal within two weeks after chemotherapy. No complication happened. CONCLUSION: 1. Internal iliac arteriography has practical significance in assessing the tumor size and evaluating the therapeutic effects; 2. the internal iliac arterial infusion chemotherapy can reduce the tumor size, which prepares the patient in a better condition for operation. The most appropriate time for operation is two weeks after internal iliac arterial infusion chemotherapy. Even for the patient who is not suitable for operation, the reduction of the tumor size still can enhance the therapeutic effects of radiotherapy. 3. IRT is easy to perform, effective and with few slight side effects and complication. It is an effective way to save the patient's life.